Medical response to Trump requires truth seeking and respect for patientsBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j661 (Published 07 February 2017) Cite this as: BMJ 2017;356:j661
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Medical response to Trump requires truth seeking and respect for patients.
Peter J. Archer opines that “…vaccine safety has become a ‘hot button’ topic and that culture war is raging between two extremes, on one side “all vaccines are inherently safe, and effective, by definition” argument, and on the other the people arguing the exact opposite. With the extremists on both sides engaging in highly emotional name-calling and hysteria, it has become almost impossible for a rational voice to be heard…”
In reality (not just as I see it) it is the proponents of vaccination who resort to irrational arguments and name-calling, and abusive emails and worse, while failing to provide scientific evidence for their assertion that all vaccines are safe and effective, ignoring the product inserts and orthodox medical research articles pointing out that vaccines do cause a long list of serious reactions, including deaths and that all outbreaks and epidemics occur in the vaccinated. As such they actually provide most of the evidence (besides case reports by parents of the affected babies, children, and adults) for those who oppose vaccination, and including myself.
I have studied by now more than 400 000 pages of medical papers (and counting) published in peer-reviewed medical and scientific journals and as such I should be in a position to provide an informed opinion and overview of vaccines’ effects.
I don’t see it as war of any kind, just truthful reporting. If with my knowledge I would still “believe” that vaccines are safe and effective I would not be able to claim rationality. I don’t use the words ‘believe’ or ‘belief’, the proponents of vaccination do. They are the ones who resort to argumentum ad hominem, often instead of argumentum ad rem, and attack those who are just pointing to the documented facts, as a rule sourced from the bona fide medical literature and product inserts and the eye witness reports by parents/carers.
What matters is the objective reality that exists on its own without people even knowing about it and irrespective of their affiliations.
It is the proponents of vaccination that often endeavour to silence those who see the objective truth and who even marginally criticise their sacred cow. It doesn’t help to proclaim, “I am not against vaccination, I just want safe vaccines” they will be branded by the proponents of vaccination as extremists and at times attacked in the most serious manner.
As a vocal opponent of all and any vaccines because of the overwhelming scientific evidence of their ineffectiveness (far from preventing the targeted diseases actually causing them) and the documented deleterious effects. I don’t care whether they continue publishing a lot of their undocumented hollow statements which to the informed and discerning readers provide further evidence of their ignorance and a lack of scientific acumen. However, I am totally opposed to them using the power of the state to enforce and mandate their toxic and deadly vaccines and refusing to accept responsibility. Worse still, to use the law and the court system to accuse, prosecute and incarcerate the innocent parents/carers of causing what eminently are vaccines’ deleterious effect and deaths, alleging the much discredited, invalid, infamous, indeed not much short of criminal, shaken baby syndrome and its synonyms.
I rarely get 'psycho' emails, one or two over the years, and after responding “Please, keep emailing me, you write very interestingly”, I never heard from the one of them again. And the other admitted that all his/her three children are autistic. Without actually saying it, I felt that he/she perhaps could not admit it to himself/herself that he/she caused his/her childrens’ autism by taking them to the doctor to be vaccinated.
As for the emotionality: on my books it is cruel to demand that the opponents of vaccination stay unemotional when so many children are seriously injured by vaccines or die. Even worse, when you are the parents or other carers falsely accused of causing the symptoms/death and all your children are taken away.
In science there is no such thing as I give an inch, and you give an inch. It is more along “the truth, the whole truth and nothing but the truth” even if you were the only one who says it. Fortunately, the numbers of those who see the truth and say it are growing.
Competing interests: No competing interests
As a medical anthropologist, my area of expertise is in the power relationships between patient and health professional, and in the forming and maintenance of the dominant discourse.
My first observation is that vaccine safety has become a ‘hot button’ topic, and that a culture war is raging between two extremes, on one side the “all vaccines are inherently safe, and effective, by definition” argument, and on the other the people arguing the exact opposite. With extremists on both sides engaging in highly emotional name-calling and hysteria, it has become almost impossible for a rational voice to be heard, and so, thank-you for publishing this call for rationality.
I have noticed that, for a significant number of people in the ‘pro-vaccine’ camp, the status of vaccines appears to have been raised to the level of what anthropology would call a ‘sacred icon’. Something that must never be criticised, or critiqued, but rather given the status of a ‘sacred cow’, to be treated with reverence. Similarly, to many in the ‘anti’ camp, the exact opposite applies. To them all vaccines are ‘evil’, to be avoided at all costs, and every piece of news of anything that could be construed to be in any way critical of a vaccine is seized on with delight, and offered up as ‘proof’ of their thesis.
In this climate of warfare, it has become very difficult to be a voice of rationality, and many people who do not wish to join either extreme camp tend to avoid the topic altogether.
This is not the forum to go deeply into the social science theories that could be applied to this. However, there is a large body of theory that could be applied, which would shed a lot of light on this heated topic. For example, the pro-v zealots could be said to be acting as enforcers of the ‘ideological state apparatus’, as per the work of the French scholar Louis Allthusser (Google it for a definition of the term). They are determined to maintain a ‘hegemony of orthodoxy’. The anti-v side could be said to be the ‘resistance’ to the dominant discourse, as per the work of Michel Foucault. Antonio Gramsci’s work on hegemony could also be used to analyse the roles of each side, as also could Foucult’s theory of ‘pastoral power’, which is a form of power that purports to ‘protect’ the citizens from some harm, and also Pierre Bourdieu’s theory of ‘symbolic power’, where the citizens surrender their own power to an ‘authority’, often the state, even when there is a cost to them in doing so. There is a quite complex interplay between all these forces and powers, which I have never seen examined, in any published forum, in relation to the vaccine wars.
To adequately examine all of this, would fill a book, a book that needs to be written, ideally in a non-partisan and unemotional manner. Certainly, there is a definite need for the tools of social science to be deployed to inject some rationality into the debate, rather than the present culture wars, between people with no knowledge of the social science, and often with little skills in critical thinking.
Competing interests: No competing interests
Peter Doshi is correct that more parents are questioning vaccine safety than ever before. A recent Economist/YouGov poll found that 31% of Americans believe that vaccines cause autism,1 and according to a Pew Research survey, 43% of parents of young children believe vaccines have high or medium risks of side effects.2 That same Pew survey found that only 52% of Americans believe that scientists usually follow the best available scientific evidence, and 79% believe that research findings are usually or sometimes influenced by researchers’ desires to help their industry.
One of the major problems is that the authorities that promote vaccines (in the United States, the Centers for Disease Control and Prevention) also provide most of the research on vaccine safety. Such agencies may not investigate problems they have created. To address this conflict of interest, Salmon et al. (2004)3 recommend a National Vaccine Safety Board similar to the U.S. National Transportation Safety Board. The NTSB promotes transportation safety by investigating accidents and suggesting improvements. It is completely separate from the U.S. Transportation Department, because, according to the NTSB website “…No federal agency can properly perform such (investigatory) functions unless it is totally separate and independent from any other … agency of the United States.”4
Separating the promotion of vaccines from vaccine safety research and investigations addresses one of the several conflicts of interest in vaccines safety. I discuss other conflicts and possible solutions in my research.5
Ignoring parents’ questions will make neither the questions nor the parents go away.
3 Salmon, DA., Moulton, L.H. and Halsey, N.A. (2004) Enhancing public confidence in vaccines through independent oversight of postlicensure vaccine safety. American Journal of Public Health, 94: 947-950.
5 DeLong, G. (2012) Conflicts of interest in vaccine safety research, Accountability in Research: Policies and Quality Assurance, 19:2, 65-88.
Competing interests: The author filed a claim under the Vaccine Injury Compensation Program for her daughter. The claim was dismissed based on untimely filing.
Discussing medical journalists, Peter Doshi argues “journalists must also ensure that patients come first, which means a fresh approach to covering vaccines. It’s time to listen – seriously and respectfully – to patients’ concerns, not demonize them”.
Certainly we must move beyond the crude ‘pro’ and ‘anti’ vaccine dichotomy that currently dominates in the science community and the mainstream media.
The antagonistic attitudes of many in the medical/scientific establishment are astonishing, with their dogmatic stance that seems to forbid questioning of any vaccine product, and denial of adverse experiences after vaccination.
Citizens in our liberal democracies are entitled to question medical interventions being instigated by governments, particularly when these interventions, i.e. vaccinations, are mandated, as is occurring in the United States and Australia.
Vaccination schedules are growing at an alarming rate, with novel vaccine products and revaccinations being added for diseases which do not pose a threat for the majority of the population, e.g. meningococcal and HPV. The processes that result in such vaccine products being added to the schedule must be open to scrutiny and challenge by the community.
Vaccination policy is a matter which impacts on all citizens and we are entitled to be consulted about the imposition of vaccine products. Instead, government vaccination bureaucracies conflicted by associations with the pharmaceutical industry are adding more and more vaccine products to the schedule, without objective and independent oversight.
So yes, it’s time for a fresh approach to covering vaccines, one that is open and transparent and which respects the right of informed citizens to question and challenge vaccination policy.
Competing interests: No competing interests
At last the BMJ has published a plea for a thoughtful "truth seeking" attitude towards patients or parents in the matter of vaccination. Or, if I may be permitted to use the term "immunisation ".
Having been involved in " imm and vac" in most of my working life and having championed the procedures, I became disenchanted when I found that doctors did not always take notice when a parent questioned the POSSIBILITY of a cause-effect relationship between an unexpected climical episode in close temporal relation with prior immunisation.
A look at the rapid responses over the years will show that our (British) public health consultants have almost never countered those who questioned the policies.
The new President may not be everyone's cup of tea. But should he set up a commission under a lawyer or a judge to explore the POSSIBILE adverse reactions of the immunisation products, we ought to welcome it.
Competing interests: No competing interests
I would like to express my appreciation to the author of this article as well as to take the opportunity to share my thoughts on the future of vaccine safety communication.
One problem that I have noted with medical journalism as well as with public health authorities regarding vaccines is the near complete avoidance to recognise the progress which has been made in the area of vaccine safety science.
There is an emerging field within vaccinology called adversomics which acknowledges the fact that adverse events following immunisation (AEFI) may be individually determined. This field is based upon the research that has identified that there is inter-individual variation in vaccine responses based upon differences in innate immunity, microbiomes, and immunogenetics.1
There are a number of publications in the literature which describe links between AEFI and individual variation. In the case of narcolepsy and Pandemrix, one of the pandemic influenza vaccines, it was discovered that children with a specific HLA type (DQB1*06:02) elicited a different level of immune response, including autoantibodies which reacted against cells in the CNS responsible for the production of hypocretin.2 Other examples would be the discovery of genetic variants which are associated with an increased risk of febrile convulsions after MMR 3 and local and systemic events after smallpox vaccination 4. Finally, another important publication would be that of Sobolev et al which discovered a unique immunological signature response in subjects experiencing AEFI after Pandemrix compared to those who did not.5
Today’s public is typically underestimated by both medical journalists as well as public health authorities. They are aware of the birth of personalised or ”precision medicine” and are cognizant of growing interest in “patient-centeredness” which strives for an understanding of the patient’s perspective of health conditions and treatment. It is very likely that they have grown to understand that the “one size fits all” argument for vaccines no longer holds, and that their voices are integral to their own health care.
A recent report from the Vaccination Confidence Project out of the London School of Hygiene and Tropical Medicine has noted very concerning low levels of trust in vaccine safety in Europe as well as Japan.6 The current strategies of communication around vaccine safety obviously are not working.
Continued failure to engage with patients and to acknowledge advancements in vaccine safety science that may challenge old paradigms will likely lead to worsening loss of public confidence in both medical journalism as well as public health authorities.
1 Poland GA, Ovsyannikova IG, Jacobson RM. Adversomics: the emerging field of vaccine adverse event immunogenetics. Pediatr Infect Dis J. 2009 May;28(5):431-2. doi: 10.1097/INF.0b013e3181a6a511.
2 Saariaho AH, Vuorela A, Freitag TL, et al. Autoantibodies against ganglioside GM3 are associated with narcolepsy-cataplexy developing after Pandemrix vaccination against 2009 pandemic H1N1 type influenza virus. J Autoimmun. 2015 Sep;63:68-75. doi: 10.1016/j.jaut.2015.07.006.
3 Feenstra B, Pasternak B, Geller F, et al. Common variants associated with general and MMR vaccine–related febrile seizures. Nature Genetics 2014; 46, 1274–1282. doi:10.1038/ng.3129
4 Reif DM, McKinney BA, Motsinger AA, et al. Genetic basis for adverse events after smallpox vaccination. J Infect Dis. 2008 Jul 1;198(1):16-22. doi: 10.1086/588670.
5 Sobolev O, Binda E, O'Farrell S, et al. Adjuvanted influenza-H1N1 vaccination reveals lymphoid signatures of age-dependent early responses and of clinical adverse events. Nat Immunol. 2016 May 19;17(6):740. doi: 10.1038/ni0616-740b.
6 Larson HJ, de Figueiredo A, Xiahong Z et al. The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey. EBioMedicine. 2016 Oct;12:295-301. doi: 10.1016/j.ebiom.2016.08.042.
Competing interests: No competing interests